Rate of Uninsured Kids Held Steady Nationwide and Improved in 17 States in 2022

Gains Are At Risk and Inequities Persist

Updated November 27, 2023 | Posted September 27, 2022
By the Annie E. Casey Foundation
Update healthinsurance 2022

New data from the Cen­sus Bureau’s Amer­i­can Com­mu­ni­ty Sur­vey show that the U.S. rate of unin­sured chil­dren held steady at 5% in 2022, main­tain­ing the gains of 2021, and 17 states saw their unin­sured rates decline. While this is pos­i­tive news, near­ly 4 mil­lion chil­dren under age 19 still lacked insur­ance cov­er­age in 2022, and expir­ing pan­dem­ic-relief mea­sures in 2023 are already caus­ing num­bers to climb.

Even when children’s unin­sured rates are at their low­est, large dis­par­i­ties per­sist by children’s race and eth­nic­i­ty, immi­gra­tion sta­tus, age and geog­ra­phy, high­light­ing our country’s inequitable access to health cov­er­age that must be addressed.

What Hap­pened Dur­ing the Pandemic

After the COVID-19 pan­dem­ic hit, Con­gress passed mul­ti­ple relief mea­sures that bol­stered the insur­ance safe­ty net for chil­dren and fam­i­lies, including:

  • increased state fund­ing for Med­ic­aid and con­tin­u­ous cov­er­age pro­tec­tion to keep states from dis­en­rolling peo­ple until April 12023;
  • reduced costs for pur­chas­ing cov­er­age through the Afford­able Care Act (ACA) health insur­ance mar­ket­place and expand­ed enroll­ment peri­ods and out­reach; and
  • expand­ed fed­er­al and state mea­sures, such as the Children’s Health Insur­ance Pro­gram (CHIP), to improve access to insurance.

Now that the Med­ic­aid con­tin­u­ous cov­er­age pro­tec­tion expired in ear­ly 2023, an esti­mat­ed 6 mil­lion indi­vid­u­als have already lost cov­er­age this year and this num­ber is expect­ed to rise — unless pol­i­cy­mak­ers take action.

What Are Med­ic­aid and CHIP?

Cen­sus Bureau analy­sis indi­cat­ed that increased enroll­ment in Med­ic­aid and CHIP was behind the reduced U.S. rate of unin­sured chil­dren in 2021, but what do these pro­grams entail?

  • Med­ic­aid is a large pub­lic health insur­ance pro­gram for chil­dren and adults who meet a low-income eli­gi­bil­i­ty thresh­old. Under the ACA, states can expand Med­ic­aid eli­gi­bil­i­ty to more low-income fam­i­lies. In 2022, all but 12 states had expand­ed their Med­ic­aid eli­gi­bil­i­ty require­ments.
  • CHIP is anoth­er pub­lic insur­ance pro­gram for chil­dren in fam­i­lies whose incomes are too high to qual­i­fy for Med­ic­aid but like­ly too low to afford pri­vate insurance.
  • While kids and young adults can be cov­ered under a parent’s or guardian’s insur­ance plan up to age 26, only chil­dren under age 19 can qual­i­fy for Med­ic­aid or CHIP.

One-in-Three Chil­dren Rely on Pub­lic Insurance

Nation­wide, about one-third of kids (34%) received pub­lic health insur­ance in 2022, while near­ly half (48%) were cov­ered through employ­er-based insur­ance. Far few­er chil­dren had oth­er types of cov­er­age, includ­ing a mix­ture of pub­lic and pri­vate insur­ance (5%), a plan pur­chased direct­ly from an insur­ance com­pa­ny (5%) or oth­er pri­vate insur­ance (2%).

At the state lev­el, the share of kids who rely on pub­lic insur­ance ranged from 14% in Utah to more than half (52%) in New Mex­i­co in 2022.

Why Insur­ing Chil­dren Matters

Kids with insur­ance are more like­ly to access time­ly med­ical care for health needs. They have improved phys­i­cal, men­tal and behav­ioral health out­comes com­pared to those with­out cov­er­age. Poor health dur­ing child­hood can affect vir­tu­al­ly every area of a child’s life, includ­ing school per­for­mance, and can have last­ing con­se­quences on health, well-being and finan­cial secu­ri­ty into adulthood.

Chil­dren eli­gi­ble for pub­lic insur­ance are espe­cial­ly like­ly to see the ben­e­fits of health cov­er­age, includ­ing increased eco­nom­ic sta­bil­i­ty for their fam­i­lies. For instance, when a fam­i­ly receives Med­ic­aid, they can use more of their income on oth­er basic needs like food and hous­ing. Med­ic­aid has also been linked to reduced med­ical debt and bank­rupt­cies, and it is con­sid­ered one of the nation’s lead­ing anti-pover­ty programs.

Insur­ing par­ents helps chil­dren, too. It increas­es the like­li­hood of parental health and strength­ens par­ents’ abil­i­ty to care for their children.

Children’s Risk of Being Unin­sured Varies by State

Dif­fer­ences in state poli­cies and prac­tices, as well as local eco­nom­ic con­di­tions, large­ly influ­ence the vari­a­tion in access to cov­er­age across the coun­try. Over­all, chil­dren are more like­ly to lack insur­ance in the South­ern and West­ern regions of the nation. In 2022, the North­east states of Mass­a­chu­setts and Rhode Island had the low­est unin­sured rates (both 2%), while Texas had the high­est rate, with 11% — or 854,000 kids — lack­ing insurance.


How­ev­er, Texas was among the 17 states that improved in 2022, with its rate of unin­sured chil­dren declin­ing by one per­cent­age point since 2021. The oth­er 16 states and the Dis­trict of Colum­bia that made gains in 2022 also saw declines of one to three per­cent­age points. Despite this progress, rates of unin­sured chil­dren increased in sev­en states in 2022, each by one per­cent­age point.

Inequities Per­sist, Par­tic­u­lar­ly for Amer­i­can Indi­an and Alas­ka Native Children

The rate of unin­sured Amer­i­can Indi­an and Alas­ka Native chil­dren has been more than twice the nation­al rate in all five years of data avail­able on the KIDS COUNT Data Cen­ter, although the per­cent­age for these kids improved for the sec­ond year in a row from 14% in 2019 to 11% in 2022. The unin­sured rate for Lati­no chil­dren has also remained high­er than the nation­al lev­el for five years but fell by one per­cent­age point to 8% in 2022. Black chil­dren saw a slight improve­ment as well, from 5% to 4% of kids with­out insur­ance. From 2021 to 2022, fig­ures remained even for kids of two or more races (6%), white kids (4%) and Asian and Pacif­ic Islander (4%) children.

In addi­tion, immi­grant chil­dren, par­tic­u­lar­ly those who are undoc­u­ment­ed, are at increased risk of being unin­sured com­pared to their peers with U.S. cit­i­zen­ship. The Cen­sus Bureau report­ed that 1 in 4 (25%) non-cit­i­zen chil­dren were unin­sured in 2022, an increase from 23% in 2021. Fig­ures were near­ly as high for for­eign-born kids as a whole, regard­less of citizenship.

Young adults are vul­ner­a­ble, too, as they are the most like­ly of any age group to be unin­sured. The most recent data from the Cen­sus Bureau’s House­hold Pulse Sur­vey in the fall of 2022 showed that 17% of young adults ages 18 to 24 lacked health insurance.

Address­ing Inequities and Bar­ri­ers to Health Insurance

Although pan­dem­ic-era poli­cies helped many chil­dren and fam­i­lies access and keep cov­er­age dur­ing this nation­al health cri­sis, mil­lions of chil­dren and young adults still lack health insur­ance, and con­cern­ing dis­par­i­ties in access to cov­er­age remain. Con­cert­ed action is also need­ed just to main­tain the gains made in recent years, rec­og­niz­ing that as the fed­er­al man­date for states to ensure con­tin­u­ous Med­ic­aid cov­er­age has end­ed. States, too, can take action to keep eli­gi­ble fam­i­lies enrolled in Med­ic­aid or help them enroll in oth­er plans. Fed­er­al law­mak­ers can also make per­ma­nent the pan­dem­ic-era improve­ments to the ACA mar­ket­place, as these were effec­tive in increas­ing cov­er­age but will expire after 2025.

Pol­i­cy­mak­ers and lead­ers in mul­ti­ple sec­tors must con­tin­ue work­ing toward sys­temic change to address the long-stand­ing inequities and bar­ri­ers that con­tribute to the dis­pro­por­tion­ate­ly high unin­sured rates among Amer­i­can Indi­an/​Alaska Native and Lati­no chil­dren. Addi­tion­al­ly, lead­ers should remove bar­ri­ers for immi­grant fam­i­lies to enroll­ment in Med­ic­aid and the ACA health insur­ance mar­ket­place, and sup­port strate­gies to increase enroll among young adults. Lead­ers at all lev­els can take steps to sim­pli­fy the sys­tem and improve access to cov­er­age, par­tic­u­lar­ly for the most vul­ner­a­ble populations.

More Child and Fam­i­ly Health Resources

See all health insur­ance data on the KIDS COUNT Data Cen­ter, includ­ing these new­ly updat­ed indicators:

Addi­tion­al resources:

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